The blank is used as an insurance bill for the services rendered to physicians in their own practice with assistance from outside medical providers. The template contains information about the client, respective diagnoses, treatment, and medicine used and/or received.

What Are the Differences Between the CMS-1500 and UB-04 Claim Form?

Both samples are used in the medical insurance industry. However, they are not interchangeable. The CMS-1500 sample is a form used by doctors and nurses. While UB-04 is a template used by hospitals and health centers.

How Many Diagnosis Codes Can Be Submitted On the CMS 1500 Claim Form

The blank supports up to 12 medical diagnoses per paper. If you declare electronically, the template allows up to eight diagnoses to be included. They should be stated in the headers (regarding the lines, each diagnosis corresponds to one line).

What Goes in Box 9 of a CMS 1500 Form

Box 9 indicates that the patient can be covered by a different insurance policy. Make sure to include the insured's full name.

What Was the Last Change Made to the CMS 1500 Sample and When

The updates introduced to the sample include the following:

  1. The SSN was replaced with ID#.
  2. The patient status request in line 8 was deleted.
  3. In line 9, other insured’s DOB, sex, and physicians education tabs were deleted.
  4. Line 11b was renamed to ‘Other Claim ID.’
  5. Row 14 was renamed to ‘Date of Current Illness, Injury….’
  6. Line 19 was renamed to the ‘Additional Claim Information.’
  7. Row 22 was renamed to ‘Resubmission.’
  8. Row 30 was renamed to ‘Rsvd for NUCC use.’

The updated document was validated after April 1, 2014.